Objective: Pure akinesia with gait freezing (PAGF)-mimicking disorders remain to be further elucidated.

Background: Hydrocephalus is a poorly elucidated disorder. Aqueductal stenosis (AS) is a well-known cause of obstructive hydrocephalus, and AS-related hydrocephalus has not been reported for the differential diagnosis of PAGF phenotype.

Methods: We report a rare case presenting as PAGF mimicking phenotype, resulting in late onset idiopathic AS-associated hydrocephalus. A 68-year-old man, with no family history for movement disorder, was admitted in our hospital because of gait disturbance with one year duration. Neurological examination showed a moderate to severe degree of symmetric bradykinesia and freezing of gait, resulting PAGF phenotype.

Results: From 1.5-T brain MRI scans, we observed not only enlargement of lateral ventricles, but also periventricular hyperintensity in contact with lateral ventricles in axial fluid attenuated inversion recovery (FLAIR) images Coronal T2-weighted images were evaluated as enlarged ventricles, tight high-convexity and medial surface subarachnoid spaces, and bilaterally expanded Sylvian fissure, suggesting disproportionately enlarged subarachnoid-space hydrocephalus (DESH). Ventriculoperitoneal shunt was applied. About one week after the VP shunt operation, his PAGF symptom were notably improved without any medication.

Conclusions: We described a case of hydrocephalus presenting as PAGF-mimicking symptoms, inferring that clinicians should pay attention to the possibility of hydrocephalus, one of treatable diseases, in diagnosing patients with PAGF.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/an-elderly-patient-presenting-as-pure-akinesia-with-gait-freezing-pagf-idiopathic-aqueductal-stenosis-associated-hydrocephalus/